Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-7266
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4924 S MAPLE TREE DR, PRINCETON, IN 47670-9278
(812) 385-0757
(812) 385-0759
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60006362A
IN
3336I0012X
Institutional Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2142896
PK
—
Enumeration date
09/23/2013
Last updated
06/10/2025
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